Authors (including presenting author) :
Chan LW(1), Yung MW(1), Tai YF(1), Yau WM(1), Wan SY(1), Yeung SF(1), Kwong SF(1)
Affiliation :
(1)Physiotherapy Department, Pamela Youde Nethersole Eastern Hospital
Introduction :
Shoulder pain is one of the most common musculoskeletal disorders in patients without direct trauma. Approximately 40% of people experience at least one episode of shoulder pain in lifetime (Guillen-Astete et al., 2015). According to Kachewar (2013) & Guillen-Astete et al (2015), tendinosis and calcifying tendinitis of rotator cuff are the common causes of non-traumatic shoulder pain. Moya et al (2018) supported the use of extracorporeal shockwave therapy (ESWT) in chronic shoulder tendinitis. Li et al (2017) also concluded that ESWT was “efficacious and safe for treating patients with chronic rotator cuff tendinitis” Ultrasound imaging in musculoskeletal imaging has become more popularly used in physiotherapy. Jopowicz et al (2017) stated that ultrasound imaging “is a novel method with a high clinical potential to support physiotherapeutic therapies”. Ultrasound imaging guided ESWT in treating patients with shoulder pain was therefore introduced to improve the effectiveness in ESWT.
Objectives :
To evaluate the effectiveness in the application of ultrasound imaging guided ESWT in people with chronic shoulder pain.
Methodology :
Subjects 1) with non-traumatic shoulder pain more than 6 months, 2) not on anti- coagulant drugs, 3) not contra-indicated to shockwave treatment and 4) discharged from education and exercise sessions were recruited to a 3-session shockwave treatment. Subjects with previous shoulder surgery, cervical syndrome findings, rheumatic arthritis, tumor and pregnancy were excluded. Physical outcomes included Numeric Pain Rating Scale (NPRS), Quick Disability of the Arm Shoulder and Hand (DASH) questionnaire and shoulder range of motion (ROM) were assessed at baseline and after intervention. Phone follow-up was also conducted in post 6-month period.
Result & Outcome :
Total 44 subjects were recruited from February to October 2019. The data collected at baseline and post-intervention was analyzed by paired t-test. The results showed that ultrasound imaging guided ESWT had significant effects on reducing shoulder pain with decreased NPRS (Mean Difference: -1.55, 95% CI: -2.01 to -1.08) (p< 0.001) and improving upper limb function with decreased Quick DASH score (MD: -15.5, 95% CI: -20.02 to -10.99) (p< 0.001). Shoulder range was also significantly increased including flexion (MD: 12.50, 95% CI: 8.73 to 16.27) (p< 0.001), abduction (MD: 10.91, 95% CI: 6.85 to 14.97) (p< 0.001) and external rotation (MD: 11.93, 95% CI: 8.21 to 15.66) (p< 0.001). The mean subjective overall improvement was +52% after intervention. Regarding long term effects of ultrasound imaging guided ESWT, Quick DASH score of subjects improved at post 6-month period and reached minimal clinical difference (Mean Difference=30%) when compared to the data at post- intervention. Also, subjective overall improvement (mean: +67%) was further improved.
Conclusion: Using ultrasound imaging guided in treatment with ESWT for chronic shoulder pain patients could be an effective mean in facilitating the therapist in physical examination and also in the application of pain relieving modality. Further controlled trials are warranted.
